US8128643B2 - Apparatus for applying surgical clips - Google Patents

Abstract

An apparatus for applying surgical clips has a body portion housing a clip stack and a pair of jaws supported at a distal end of the body portion. The body portion includes a camming member, a clip follower and a lockout member having a plurality of stop members. The lockout member is movable from a first position in slidable relation to the camming member to a second position interlocked with the camming member. The camming member has at least one notch, and in a second position the lockout member has at least one of the stop members positioned to interface with the at least one notch. The engagement between the stop member and the notch limits distal movement of the camming member. The clip follower actuates the lockout member when the clip follower advances to a predetermined clip in the clip stack.

Description

CROSS-REFERENCE TO RELATED APPLICATION

The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 60/852,143, filed on Oct. 17, 2006, the entire content of which is incorporated herein by reference.

BACKGROUND

1. Technical Field

This present disclosure relates generally to an apparatus for applying surgical clips to tissue. More specifically, the present disclosure relates to an apparatus for applying a series of clips to tissue seriatim.

2. Background of Related Art

Surgical procedures frequently require ligation of blood vessels, severed tissues and/or other organs to control or stop bleeding. Clip applying apparatus for quickly applying a surgical clip about tissue are known. Such clip applying apparatus include single clip applicators and multiple clip applicators. In single clip applicators, a new clip is loaded into the apparatus after application of each clip. Multiple clip applicators include a series of clips which can be sequentially applied to tissue during the course of a surgical procedure. Because surgical procedures usually require the use of a multiplicity of surgical clips, multiple clip applicators are generally preferred.

Typically, clip applying apparatus include a handle mechanism, an elongated body portion, and a clip crimping assembly, e.g., a jaw or pair of jaws. Such clip applying apparatus are configured for endoscopic or open surgical procedures. Although known clip applying apparatus for sequentially advancing individual clips have provided good results, a continuing need exists for a clip applying apparatus which is less complex and provides effective occlusion of a blood vessel.

Often some issues arise where the instrument can be manipulated while not in operation such as for loading on a surgical tray prior to surgery. This movement can result in an accidental movement and/or compression of the jaws. Other issues arise where other prior art clip applier can be fired without the surgeon aware that there are no remaining clips in the instrument. The present disclosure includes clip applier subassemblies to remedy some of these longstanding concerns in an effective manner in an instrument which is less complex.

SUMMARY

In a first embodiment of the present disclosure, there is provided an apparatus for applying surgical clips. The apparatus has a body portion housing a clip stack and a pair of jaws supported at a distal end of the body portion. The apparatus has the body portion including a clip pusher, a camming member and a clip follower. The clip pusher is movably positioned within the body portion and being operable to advance a distal-most clip from the clip stack to a position between the pair of jaws. The camming member is movably positioned within the body portion and operable to approximate the pair of jaws to deform the distal-most clip. The clip follower is positioned proximally of the clip stack and operable to urge the clip stack distally towards the pair of jaws. The body portion further includes a lockout member having a plurality of stop members. The lockout member is movable from a first position in slidable relation to the camming member to a second position interlocked with the camming member. The camming member has at least one notch, and in a second position the lockout member has at least one of the stop members being positioned to operatively engage the at least one notch. The engagement between the stop member and the notch limits distal movement of the camming member. The clip follower actuates the lockout member when the clip follower advances to a predetermined position in the clip stack.

According to another embodiment, there is provided an apparatus for applying surgical clips. The apparatus has a body portion housing a clip stack; and a pair of jaws supported at a distal end of the body portion. The body portion has a clip pusher, a camming member and a clip follower. The clip pusher is movably positioned within the body portion and operable to advance a distal-most clip from the clip stack to a position between the pair of jaws. The camming member is movably positioned within the body portion and operable to approximate the pair of jaws to deform the distal-most clip. The clip follower is positioned proximally of the clip stack and operable to urge the clip stack distally towards the pair of jaws. The body portion further includes a lockout member having a plurality of stop members. The lockout member moves from a first position in slidable relation to the camming member to a second position interlocked with the camming member. The camming member has at least one notch. In the second position, the lockout member has at least one of the stop members positioned to interface with at least one notch to limit distal movement of the camming member. The clip follower actuates the lockout member when the clip follower advances to a predetermined position in the clip stack.

The apparatus also has a latch assembly supported on the clip pusher. The latch assembly includes a pivotal latch member having a member which is movable from a first position to engage an aperture supported on the clip pusher to load a clip between the jaws to a second position. In the second position, the latch member disengages to retract the clip pusher. The camming member is operably connected to a movable handle such that movement of the at least one movable handle through an actuation stroke effects movement of the camming member from the advanced position to the retracted position.

According to yet another embodiment of the present disclosure there is provided a clip follower and a lockout for a surgical hemostatic clip applier. The clip follower comprises a body having a post configured to receive a biasing member and a distal end configured to urge a clip stack in a distal manner. The clip follower also has an indexing nub on a lateral side. The nub is adapted to actuate the lockout when the clip follower has reached a predetermined position of the clip stack.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the presently disclosed clip applying apparatus are described herein with reference to the drawings, wherein:

FIG. 1 is a perspective view of one embodiment of the presently disclosed clip applying apparatus;

FIG. 2 is an enlarged perspective view of the distal end of the clip applying apparatus shown inFIG. 1;

FIG. 3 is a top view of the clip applying apparatus shown inFIG. 1;

FIG. 4 is a side view of the clip applying apparatus shown inFIG. 1;

FIG. 5 is a perspective view of the proximal portion of the handle of the clip applying apparatus shown inFIG. 4 with the top housing half-section exploded;

FIG. 6 is a perspective view of the clip applying apparatus shown inFIG. 1 with the top housing half-section removed;

FIG. 7 is an enlarged view of the distal end of the clip applier showing the jaws;

FIG. 8 is an exploded view of the body portion of the clip applying apparatus shown inFIG. 1;

FIG. 9 is an exploded view of the handle section showing the pawl, rack and pawl spring with the triggers and links;

FIG. 10 is an exploded view of the latch, latch spring and proximal end of the clip pusher;

FIG. 11 is an exploded view of the cam plate of the clip applying apparatus with a pawl spring and pawl ofFIG. 10;

FIG. 12 is an enlarged view of a clip follower shown inFIG. 8 according to the present disclosure having a lockout member in a side;

FIG. 13 is a top view of the separator plate of the clip applying apparatus;

FIG. 14 is a bottom view of the plate ofFIG. 13;

FIG. 15 is a bottom view of a cover of the clip applier showing the clip retainer spring ofFIG. 8;

FIG. 16 is a perspective view of the clip applying apparatus shown inFIG. 8 with multiple subassemblies in a partially assembled state;

FIG. 17 is an enlarged view ofFIG. 16 of the clip retainer spring with the clip stack, and jaws with the cover being removed;

FIG. 18 is a perspective view of the separator plate of the clip applying apparatus having a lockout engagement member of the lockout beneath the plate extending through the separator plate;

FIG. 19 is an enlarged perspective view of the follower with follower spring shown inFIG. 16;

FIG. 20 is a perspective view of a partially assembled clip applier instrument having the lockout, the jaws, and the latch assembly;

FIG. 21 is a perspective view of the latch and pusher spring connected to the separator plate;

FIG. 22 is a top perspective view of the lockout member having the legs for engagement with the cam plate and the lockout being adjacent the jaws as shown inFIG. 8;

FIG. 23 is a top perspective view of the jaw body of the clip applying apparatus with the clip stack and the clip pusher shown inFIG. 8;

FIG. 24 is an enlarged top perspective view of the lockout engagement member extending through the separator plate in a first idle position with the lockout being shown below the separator plate for illustration;

FIG. 25 is a partially assembled perspective view of the clip applying apparatus with the jaw safety and clip pusher and lockout engagement member;

FIG. 26 is a partially assembled perspective view of the lockout having the lockout legs for engagement into the slots of the cam plate;

FIG. 27 is a side view of the assembled clip applier;

FIG. 28 is a top view of the assembled clip applier ofFIG. 27;

FIG. 29 is a top view of the handle portion of the clip applying apparatus shown inFIG. 1 with the top handle cover removed to show the cam plate in an initial position and biased to an end of the handle portion and with the pawl adjacent the rack;

FIG. 30 is a cross sectional side view of the handle portion of the clip applier shown inFIG. 29 with the cam plate, the pawl and the latch along line30-30 ofFIG. 29;

FIG. 31 is a cross sectional side view of the body portion of the clip applier shown inFIG. 27 with the jaw safety, the clip retainer, the camming member and the lockout;

FIG. 32 is a top view of the distal end of the body portion shown inFIG. 31 with the clip pusher ready to advance a distal most clip between the jaws with the cover being removed;

FIG. 33 is a cross sectional side view of the lockout member in the body portion with the clip stack and lockout spring;

FIG. 34 is a top view of the body portion shown inFIG. 33 with the lockout member being shown under the separator plate and the clip stack in phantom dotted lines to show the flexible legs of the lockout;

FIG. 35 is a cross sectional side view of the proximal end of the body portion with the latch spring and latch;

FIG. 36 is a top cross-sectional view of the clip applying apparatus shown with the clip follower urging the clip stack in a distal manner;

FIG. 37 is a view of the camming plate and the jaws;

FIG. 38 is front cross sectional view of the body portion along line38-38 ofFIG. 31 with a cover, a clip stack, a stationary plate, a cam plate and the jaws in cross section to show placement thereof;

FIG. 39 is an enlarged view of the pawl, pawl spring and rack of the handle portion that prevent the cam plate from retracting in mid-stroke;

FIG. 40 is a top view of the handle portion showing the beginning of the stroke and the triggers being squeezed;

FIG. 41 is a cross sectional view of the cam plate being advanced distally;

FIG. 42 is a cross sectional view of the clip follower, the latch driver, the latch and latch spring being advanced distally;

FIG. 43 is a cross sectional view of the body portion with the clip retainer spring, the jaw safety and the clip pusher being advanced distally with the distal most clip being advanced distally past the clip retainer spring;

FIG. 44 is a cross sectional view of the clip retainer spring moving back to an original position to prevent the stack from moving distally as shown inFIG. 43;

FIG. 45 is a cross sectional view of the body portion showing the clip pusher and pusher spring in an elongated state being connected to the stationary plate;

FIG. 46 is a cross sectional view of the clip pusher advancing the distal most clip between the jaws and the jaw safety having a free end disposed between the jaws;

FIG. 47 is a cross-sectional view of the latch driver, latch and latch spring with the latch being cammed up and out of engagement with the latch driver;

FIG. 48 is a cross-sectional view of the latch cammed out of engagement with the latch driver to allow the clip pusher to retract with the latch driver and the cam plate being advanced distally;

FIG. 49 is a cross sectional view of the clip pusher being retracted proximally with the cam plate deflecting the jaw safety free end from between the jaws to allow the cam plate to close the jaws;

FIG. 50 is a distal view of the cam plate contacting the outer surface of the jaws for closing the jaws and a clip between the jaws;

FIG. 51 is a top view of the handle portion of the clip applying apparatus shown with the pawl contacting the teeth of the rack to prevent the cam plate from being retracted until the clip is formed;

FIG. 52 is a top view of the handle portion of the clip applying apparatus shown with the pawl being past the teeth of the rack and reset at a full stroke;

FIG. 53 is a view of the cam plate closing the jaws at a full stroke;

FIG. 54 is view of the formed clip on a blood vessel with the clip applier being withdrawn;

FIG. 55 is a top view of the handle portion of the clip applying apparatus shown inFIG. 1 with the trigger being released and the cam plate commencing retraction;

FIG. 56 is a top view of the body portion with a clip follower having a member contacting an engagement member of the lockout member;

FIG. 57 is an enlarged view of detail ofFIG. 56 showing the lockout member of the clip follower moving the engagement member of the lockout past a raised feature of the separator plate after a predetermined clip has been fired; and

FIG. 58 is a perspective view of the lockout member having the flexible legs advancing into the slots of the cam plate and the lockout tab engaging a surface on the jaws to lockout the clip applier and to prevent further distal movement of the cam plate and further actuation of the handle portion.

DETAILED DESCRIPTION OF THE EMBODIMENTS

Embodiments of the presently disclosed surgical clip applier will now be described in detail with reference to the drawings wherein like reference numerals designate identical or corresponding elements in each of the several views. Throughout this description, the term “proximal” will refer to the portion of the instrument closest to the operator and the term “distal” will refer to the portion of the instrument furthest from the operator.

Referring toFIGS. 1 through 4, the presently disclosed surgical clip applier, shown generally asreference numeral10, includes ahandle portion12, anelongated body portion14 extending distally fromhandle portion12 and first andsecond jaws16 and18. The first and thesecond jaws16,18 extend from the distal end ofbody portion14. Briefly, handleportion12 includes ahandle housing20 and a pair of movable handles or triggers22. Each movable handle or trigger22 includes afinger loop22afor receiving a finger of a surgeon's hand.

As can be understood fromFIG. 1, thehandle housing20 with thetriggers22 can be comfortably held in a surgeon's hand and actuated without any undue strain on the surgeon's fingers or palm. Thepresent clip applier10 further has a smooth outer surface that is comfortable to hold. Referring now toFIG. 2, theclip applier10 has atissue stop24 formed at a distal end of acover200 that extends above thejaws16,18 and prevents any tissue from entering a distal portion of thebody portion14. In one embodiment, thetissue stop24 is made from a visually translucent or transparent material so as to allow the surgeon the ability to visually inspect an interior through thetissue stop24 and inspect in the interior of thesurgical clip applier10.Tissue stop24 also prevents tissue from forcing/moving a clip proximally injaws16,18.Tissue stop24 also prevents/minimizes deflection ofjaws16,18.

Referring also toFIGS. 5 through 9, thehandle housing20 can be formed from molded housing half-sections20aand20b(FIG. 5) which are secured together using ascrew30. Alternately, other fastening techniques may be used to secure housing half-sections20aand20btogether, e.g., welding, rivets, interlocking structure, adhesives, etc.

In one embodiment, the distal end of each handle22 is pivotally secured about apivot member26a,26bsuch that handles22, when actuated, move in a scissor-like manner. Eachpivot member26a,26bis positioned betweenrecesses28a, and28bformed in half-sections20aand20b, respectively, and may be formed integrally with arespective handle22 or, in the alternative, as a separate element from arespective handle22.

In one exemplary embodiment, each handle22 may have a slipresistant grip member32 secured to an outside surface thereof and acam channel34 formed on aninside surface36 thereof. Slipresistant grip member32 can be formed from a cushioning material, adhered or connected or over molded onto eachhandle22. It is also contemplated that other slip resistant materials and methods of application may be used to formgrip member32 and/or applygrip member32 to thehandles22. Eachcam channel34 is configured to receive apivot member36a,36bfor connecting a pair ofpivotal links40a,40bas will be described in more detail below.

Referring now toFIG. 5, theclip applier10 has arack42 and afollower44 that is disposed through thehandle portion12. Thehandle portion12 also has a cam plate or cammingmember46 shown in a proximal most section of thehandle portion12. Thecam plate46 also extends through thebody portion14 of theclip applier10. Thecam plate46 may be a thin resilient coined member that translates the energy from thehandles22 to drive one or more internal structures of theclip applier10 with ease and repeatability.

Referring now toFIG. 6, there is shown the opposite side of theclip applier10 ofFIG. 5 except with ahalf housing section20bbeing removed for clarity. Theclip applier10 has alatch48. Thelatch48 is advanced distally by a latch driver50 (see below). Thelatch48 and thelatch driver50 are an assembly that translates energy to a clip pusher (not shown) and for loading the distal most clip between thejaws16,18. Thereafter, thelatch48 will then move proximally to withdraw the clip pusher (not shown) and permit one or more other structures to operate without any interference. Thelatch48 is connected to aclip pusher600 whilelatch driver50 is connected to thecam plate46.

Theclip applier10 further has apawl56 with apawl finger54. Thepawl finger54 is a resilient pointed member that is pivotally connected at one end to theratchet support52 and is free at the other end to interface with another structure. Thepawl finger54 at the free end interfaces with therack42 ofFIG. 5. Thepawl56 is further connected in thehandle portion12 and is connected to apawl spring57. Thepawl spring57 is mounted to thecamming member46. Thecamming member46 further has ahook58 and is connected by aspring60 to a proximal most section of thehandle portion12 in the handle housing20 (FIG. 6). As can be understood, as thecamming member46 is urged distally, the spring60 (connected to thehook58 and the handle portion12) will be stretched and then urge thecamming member46 to return proximally.

Referring toFIG. 7, there is shown a close up view of the first and thesecond jaws16,18. The first and thesecond jaws16,18 are stationary and do not move proximally or distally. Instead, the first and thesecond jaws16,18 move toward one another in order to compress a clip being disposed between the first and thesecond jaws16,18. Thebody portion14 includes a pair of distally located cutouts62 (only one of which can be seen inFIG. 7). The cutouts62 are configured to slidably receive thejaws16 and18. The cutouts62 are generally rectangular shaped and dimensioned to confinejaws16 and18 to prevent misalignment of thejaws16,18 during actuation ofclip applier10. The proximal end of thebody portion14 includes a pair of transversely extending wings64 of thejaws16,18 integrally formed therewith, which are dimensioned to be received within cutouts62.Jaws14 and16 are manufactured as a single unitary component, however, it is envisioned thatjaws14 and16 may be manufactured as two separate components.

Referring to an exploded view of theclip applier10, as shown inFIG. 8, theclip applier10 also has a jaw locking member orplate66. Thejaw locking plate66 is secured to thehousing body14 and in achannel68 of thehousing body14. Thejaw locking plate66 includes anopening70. Theopening70 is sized to receive aprojection72 formed on or in thehousing body14 to secure thejaw locking plate66 to theclip applier10. In one embodiment, thejaw locking plate66 may be connected to thehousing body14 by a screw with a washer to prevent any body fluids from entering thechannel68 and that could interfere with the operation of one or more subassemblies thereof.

FIG. 8 shows an exploded view of a number of components of thesurgical clip applier10. Thesurgical clip applier10 has acover200, afollower300, afollower spring400, aseparator plate500, aclip pusher600, a lockout orlockout member700, ajaw body800, thelatch driver50, thecamming member46, and thechannel68 of thehousing body14. The components here are shown as exploded, however, the components fit in the assembled state in thechannel68, and thecover200 connects with thehousing body14 by a snap fitting or another suitable connector. Optionally, when thehousing body14 is connected to thecover200, a poly vinyl chloride or a Mylar™ may wrap thecover200 andhousing body14 having a thickness.

As can be understood from the drawings, referring first to thejaw body800 shown between thechannel68 of thehousing body14 and thecamming member46, thejaw body800 is stationary. Thejaw body800 and includesjaws16 and18, a proximal mountingportion802 and a pair of spaced distally extendinglegs804,806.

Thejaw16 is connected to a distal end of theleg806. Theother jaw18 is also connected to another distal end of theleg804. Anouter cam surface808 is formed on an outer surface of eachjaw16 and18. As can be understood thejaws16,18 are intended to be closed by another member traversing and contacting on theouter cam surface808 of thejaws16,18 to close and compress thejaws16,18 and a clip being disposed between thejaws16,18. The cam surfaces808 are positioned to be engaged by anengagement member84 connected to thecam plate48 shown immediately above thejaw body800.

Thejaw body800 is mounted within thechannel68 of thehousing body14 using amember74 such as a bolt or fastener. Thefastener74 extends through anopening76 in thechannel68 of thehousing body14.

Thecamming member46 shown immediately above thejaw body800 inFIG. 8 as a rectilinear structure that extends through thehousing body14 and into thehandle housing20 as shown inFIG. 5. Thecamming member46 has aproximal end80 that has thehook58 as shown inFIG. 5. Thecamming member46 also has adistal end82. Thecamming member46 is supported in thechannel68 of thehousing body14. Thedistal end82 has theengagement member84 that although is shown as being apart from thejaw body800, theengagement member84 rides up on theouter camming surface808 when assembled. Theengagement member84 is also a rectilinear shape and is sized to interface with the camming surfaces808 of thejaw body800, however alternatively, thecamming member46 may have an interlocking jaw closing structure that rides up along a camming surface that is on a top of thejaw body800 such as disclosed in copending U.S. Provisional Patent Application Ser. No. 60/617,104 filed on Oct. 8, 2004; U.S. Provisional Patent Application Ser. No. 60/617,016 filed on Oct. 8, 2004; and U.S. patent application Ser. No. 11/245,523 filed Oct. 7, 2005 which are all herein incorporated by reference in their entirety.

Thecamming member46 is slidably supported withinchannel68 of thehousing body14. Theengagement member84 is positioned about the legs ofjaw body804,806 in an initial unfired position. Theengagement member84 can have a substantially rectangular configuration and is formed by a one piece member that is wrapped around thedistal end82 and has an interlocking portion that secures theengagement member84 to thecamming member46. Alternatively, another configuration is contemplated such as a square, curved or a “C” shaped configuration, or thecamming member46 and theengagement member84 may be formed from one molded, stamped or coined piece. Various configurations are possible and within the scope of the present disclosure, and thesurgical clip applier10 may be made with anysuch camming member46. Various configurations are possible and within the scope of the present disclosure.

Handles22 ofhandle portion12 shown inFIG. 5 are operable to movecamming member46 between a retracted position and an advanced position along thechannel68 of thehousing body14. In the retracted position ofcamming member46, theengagement member84 is positioned aboutlegs804,806 of thejaw body800 at a location proximal of theouter cam surface808. In the advanced position ofcamming member46, theengagement member84 advanced distally and is positioned about thejaws16 and18 past theouter camming surface808 or in abutting relation to the outer cam surfaces808.

Referring still toFIG. 8, above thecamming member46 is theclip pusher600 for advancing a single surgical hemostatic clip between thejaws16,18. Theclip pusher600 has anelongated body602, adistal finger604, and a proximallatch assembly mount606 opposite thedistal finger604. Thedistal finger604 is on adistal end608 of theclip pusher600. Thedistal finger604 has an elongated semi-circular shape and is positioned to engagedistal-most clip86 of the stack ofclips88 when theclip pusher600 is moved from a retracted position to an advanced position. In this manner, thedistal finger604 will advance only the distalmost clip86 for compression between thejaws16,18. Referring to an opposite orproximal end610 of theclip pusher600 is thelatch assembly mount606. Thelatch assembly mount606 has a pair of spaced,vertical brackets612. Thevertical brackets612 have anopening614. Theopening614 is sized to receive pivot pins96 of thelatch48.

The pusher latch assembly generally90 has thelatch48, alatch spring94, and pivot pins96 that extend on the outermost sides of thelatch48. Alternatively, the pusher latch assembly90 may have onepin96 that extends through thelatch member48, or yet another connector to translate energy from thehandles22 to theclip pusher600. Thelatch member48 has thepins96 pivotally secured at a distal end in theopening614 of thelatch assembly mount606 of theclip pusher600. Theopening614 is a semicircular shaped opening on a bottom side of thelatch assembly mount606 that is formed in thebrackets612 that are generally orthogonal relative to one another.

Thelatch spring94 is positioned between the proximal end ofclip pusher600 and thelatch48. Thelatch spring94 urges thelatch48 away fromclip pusher600. Accordingly, thepins96 of thelatch48 engage theopening610 of theclip pusher600 when thecamming member46 moves to the advanced position.

Thelatch48 is pivotal against the urging oflatch spring94 and towards theproximal end610 ofclip pusher600 to movelatch48 out of engagement with theopening614 as will be discussed in further detail below.

Referring still toFIG. 8, theclip applier10 also has theseparator plate500. Theseparator plate500 is fixedly supported betweenhousing body14 and ahousing cover200. Theseparator plate500 has a series ofprojections502. Theprojections502 are dispersed about theseparator plate500 and theprojections502 are received inrecesses202 formed inhousing cover200. In this manner, theseparator plate500 is secured to thehousing cover200, and is fixably supported in theclip applier10 to be stationary relative to the other components. Moreover, other components of theclip applier10 can be connected to thestationary separator plate500 and move relative to theplate500 without disturbing an orientation of theseparator plate500.

Referring now to the distal end ofseparator plate500, the separator plate has a pair of spacedspring fingers504,506. The distalmost fingers504,506 are positioned to guide thedistal-most clip86 ofclip stack88 in between thejaws16 and18. One should appreciate that at no time before the distalmost clip86 is positioned between thejaws16,18, the geometry of the clip is undisturbed and that theclip86 is in no way deformed, knocked, nicked or compressed prior to entering thejaws16,18 as this may disturb the manner in which theclip86 is compressed around a vessel. Theclip applier10 advantageously maintains the geometry of theclip86 prior to compression thereof.

Referring now toFIG. 14, thereseparator plate500 has afirst hook508 that is on a firstbottom side510 of theseparator plate500. Thefirst hook508 engages with biasing device for thelockout700. Theseparator plate500 also has asecond hook516. Thesecond hook516 connects with another biasing device for theclip pusher600, or apusher spring616 shown inFIG. 8. Thepusher spring616 connects with theseparator plate500 by hooking on thesecond hook516. The coiledpusher spring616 is tensioned. The coiledpusher spring616 urges theclip pusher600 to its retracted position once theclip pusher600 is advanced distally.

Referring back toFIG. 13, theseparator plate500 also has alockout member512, which will be discussed in detail below. Thelockout member512 is an orthogonal shaped member that extends perpendicular to a normal face of atop side514 of theseparator plate500. Thelockout member512 biases thelockout700 until such time as theclip follower300 advances a portion of thelockout700 past themember512.

Referring again toFIG. 8, when thehandles22 shown inFIGS. 1 through 4 are operated to movecamming member46 from its retracted position to its advanced position, theabutment member96′ engages thelatch48. Theabutment member96′ is a raised feature on thecamming member46 that urges thelatch member48 and theclip pusher600 in a distal direction or toward a distal most advanced position against the urging ofpusher spring616. As discussed above, thepusher spring616 is connected to thesecond hook516 of theseparator plate500 shown inFIG. 13. Asclip pusher600 moves distally withcamming member46, adistal finger604 of theclip pusher600 engagesdistal-most clip86 of theclip stack88. In this manner, the distalmost clip86 is advanced by thefinger604 betweenjaws16 and18.

Referring still toFIG. 8, alatch driver50 is supported in thechannel68 between thehousing body14 and thehousing cover200. Thelatch driver50 is a “U” shaped member having anaperture102 being disposed therethrough. Theaperture102 has apin104. Thepin104 or fastener may be any fastener in the art that is disposed through theaperture102 and connects thelatch driver50 with thecamming member46.

Thelatch driver50 is positioned incam channel68 at a position to engage thedistal end80 oflatch member48. Thelatch driver50 slides and disengages latchmember48 from theabutment member96′ whendistal-most clip86 has been fully advanced intojaws16 and18. When thelatch driver50 is disengaged fromabutment member96′, thepusher spring616 returns theclip pusher600 to its retracted position. Althoughlatch driver50 is illustrated as having a “U” shape other configurations are envisioned.

Referring toFIG. 8, theclip stack88 may have any number of surgical hemostatic clips in thestack88 for applying the clips to body tissues in a repeated fashion. Thestack88 is slidably supported ontop side514 of theseparator plate500. Theclip follower300 is positioned behind theproximal-most clip104 of the array of the clips in theclip stack88. Theclip follower300 includes a pair of distally extendingarms302,304, and abody portion306. Thedistal end308 of each of theclip follower arms302,304 is configured to engage an apex or another portion of theproximal-most clip104.

Theclip follower300 also has atop surface308. Referring now toFIGS. 8 and 12, thetop surface308 of theclip follower300 has a member orpost310. Themember310 is generally cylindrical shaped and has thespring400 in coaxially alignment with themember310 in order to bias themember310 distally and to advance a distalmost clip86 between thejaws16,18 by applying a force to thearms302,304 which apply the force to thestack88. Theclip follower300 has an advantageous lockout tab ornub314, best shown inFIG. 12.

Thelockout tab314 is a rectilinear shaped member that extends from a lateralproximal side316 of theclip follower300. Thelockout tab314 is positioned to engage another or second member of theclip applier10 that is disposed on alockout700 and will be discussed in detail further to lockout theclip applier10 when theclip applier10 has no remaining clips or has few clips left in thestack88 to prevent theclip applier10 from being actuated without available clips for occlusion. Thelockout tab314 acts as an indexer and travels distally each time theclip applier10 is fired and the number of clips from theclip stack88 are applied to tissue for occlusion. At a certain line of demarcation in order to prevent theclip applier10 from further operating and dry firing the clip applier, theclip applier10 will lock and not fire when thehandles22 are compressed. This provides the surgeon with a tactile feedback that thehandles22 can no longer be compressed. Thus, thelockout tab314 is positioned to travel in thehousing body14 and is movable withclip follower300 asclip follower300 is advanced to moveclip stack88 distally withinelongated body portion14.

Referring still toFIG. 8, theclip applier10 has aclip retainer spring106. Theclip retainer spring106 has a curvedclip retainer member108 and afastener110. Thefastener110 is connected through theclip retainer spring106 and is connected to thehousing cover200 of theclip applier10. Theclip retainer spring106 is further connected at a distal end of theclip applier10 and will be discussed further herein.

Ajaw locking member66, e.g., plate (FIG. 8) is also provided and is shown above thebody portion14 and thejaw body800 in an exploded fashion. The jaw locking member orjaw safety66 is secured to thehousing body14 and in thechannel68 of thehousing body14. Thejaw locking plate66 has one or a number ofopenings70. Theopenings70 of thejaw locking plate66 are dimensioned to receive the projection72 (FIG. 25) formed on thehousing body14 to secure thejaw locking plate66 to thehousing body14. Thejaw locking plate66 or safety has a resilient andflexible arm116 on adistal end118 which is positioned between thelegs16,18 of thejaw body800 to prevent thejaws16,18 from being closed inadvertently during positioning ofclip applier10 at a surgical site. Again, thepresent clip applier10 controls thejaws16,18 and separates thejaws16,18 to prevent thejaws16,18 from any premature compression, knocking or altering of theclip86 by thejaws16,18 prior to theclip86 being compressed and applied to the surgical site for occlusion.

Referring now toFIGS. 25 and 26 (with theclip pusher600 being removed inFIG. 26 for illustration purposes), when thecamming member46 is moved to its advanced position, thedistal end82 of thecamming member46 moves theengagement member84 of thecamming member46. This movement (of the engagement member84) is indicative that the surgeon has squeezed thehandles22 ofFIG. 5 to almost a full stroke, and is indicative that the surgeon now wishes to apply theclip86 for occlusion. This movement (of the engagement84) deflects thearm116 of thejaw locking member66 in a downward manner to move thearm116 of thejaw locking member66 from between thejaws16,18 to a position out of way of thejaws16,18. Thus, thejaw locking member66 can deflect to allow for the closure ofjaws16,18 (FIGS. 25 and 26). Alternately, thejaw locking member66 need not be in the form of a rectilinear flat plate but rather other configurations are envisioned, e.g., cylindrical or another cantilevered configuration positionable betweenjaws16,18 to prevent closure of thejaws16,18. Any cantilevered shapedjaw locking member66 is possible and within the scope of the present disclosure.

Referring toFIGS. 8 and 22, alockout member700 is positioned above thecamming member46 in thechannel68 of thehousing body14. Thelockout member700 has acentral body portion702, a pair offlexible legs704,706 and a proximally extendinglockout engagement member708. Thelockout engagement member708 is a rectilinear member that extends from abottom surface710 of thelockout member700.

Thecentral body portion702 also includes anaperture712 in a centermost portion714 of thecentral body portion702. Thelockout700 haslegs704,706 extending an end of the lockoutcentral body portion702. Thelegs704,706 engage with anotch120 formed in thecamming member46 shown inFIG. 8. Further theseparator plate500 shown above has the first hook508 (FIG. 22). Thefirst hook508 connects a lockout spring724 (shown inFIG. 8) and thespring aperture712 of thelockout member700. Thelockout spring724 biases thelockout member700 relative to thestationary separator plate500.

Theseparator plate500 releasably retainslockout member700 at a fixed position in relation to theseparator plate500 until an external force is applied to thelockout engagement member708 by theclip follower300. Simply stated, the lockout tab314 (FIG. 12) of theclip follower300 will move thelockout engagement member708 as will be discussed in detail below to lockout theclip applier10.

Referring now toFIGS. 20 and 22, thelockout700 also has the first and the second proximally locatedflexible legs704,706. Each of theflexible legs704,706 of thelockout member700 has a radial projection oredge718. Thelegs704,706 are positioned within the confines or the sidewalls of thecam member46 and are biased inwardly a predetermined amount by sidewalls122 (FIG. 8).

FIG. 8 shows thenotch120 formed in the opposite sides of thesidewalls122 of thecamming member46. Accordingly, when thelockout member700 is moved so that thelegs704,706 are in direct alignment with thenotch120, thelegs704,706 of thelockout member700 will move not being constrained by thesidewalls122 of thecamming member46. Thelegs704,706 will spring in a direction outwardly and be free from the constraint of thesidewalls122. Thelegs704,706 of thelockout member700 move the radial projections or edge718 of thelegs704 into thenotch120. When thelegs704,706 are positioned within thenotch120, thelockout member700 is fixedly secured to thecamming member46.

As discussed above, thefollower300 is urged distally by the biasing member orfollower spring400. Thefollower spring400 urges theclip stack88 distally alongseparator plate500. Each clip is advanced between thejaws16,18, because theclip follower300 moves further distally withinelongated body14 due to the bias of thefollower spring400.

As theproximal-most clip104 or a predetermined clip prior to the proximal most clip (such as with one, two or three clips remaining in the stack88) is advanced in between thejaws16,18 alockout tab314 offollower300 engages alockout engagement member708 of thelockout700 and effects distal movement oflockout700 in relation to thecamming member46, such that afterproximal-most clip104 is crimped between thejaws16,18 and thecamming member46 is returned to its retracted position, the radial projection or edge718 of thelegs704,706 of thelockout700 align with thenotch120 in thecamming member46 to fixedly secure thelockout700 to thecamming member46 and thus prevent further movement of the camming member46 (FIG. 26).

Referring now to the jaw body800 (shown between thehousing body14 and thecamming member46 inFIG. 8), thejaw body800 has astop member810 secured to aproximal end812 of thejaw body800. Alternately, other stop member configurations are envisioned so as to prevent any movement oflockout700 as a portion of thelockout700 can engage thestop member810 to prevent thecamming member46 from moving distally. This also prevents contact with theouter cam surface808 of thejaw body800.

The distal end oflockout700 includes atab720. Thetab720 is a curved structure that is in a distal side of thelockout700. Thetab720 curves slightly downwardly. Thetab720 contacts thestop member810 that is formed in a stepped down surface in theproximal side812 of thejaw body800. As discussed above, after theproximal-most clip104 has been applied to tissue, thelockout700 is fixedly secured to thecamming member46. The engagement between thelockout tab720 and anotherstop member810 prevents distal advancement of thecamming member46.

As will be discussed below, since thecamming member46 is connected vialinks40a,40bto handles22 (FIG. 1), the engagement between thelockout700 and thecamming member46 prevents actuation of thehandles22. In fact, if the surgeon attempts to compress thehandles22, thehandles22 will provide a stiff resistance to the compression and thus, indicate by a tactile feedback to a surgeon that the clipapplier clip stack88 has been depleted.

Referring toFIG. 9, thehandle portion12 has thecamming member46 having theproximal end80. Theproximal end80 of thecamming member46 has thehook58.Hook58 connects to thespring60 that is connected to thehandle housing20 at a proximalmost location128 of thehandle housing20.

Theclip applier10 haslinks40aand40bof a linkage assembly which connectshandles22 to theproximal end80 of thecamming member46. Theproximal end128 of thelinks40a,40bare pivotally secured to theproximal end80 of thecamming member46 respectively, bypivot members130.

Thelinks40a,40bare connected to thecamming member46 by thepivot members130 andlinks40a,40bare pivotally mounted betweenbores132 formed in each of thelinks40a,40b(FIG. 5). Thelinks40a,40bare received within arespective cam channel34 formed in arespective handle22. When handles22 are actuated, i.e., moved towardshandle housing20a,20b, thelinks40a,40bare caused to move throughcam channels34 such that thelinks40a,40bare moved from a first position towards a second position (FIGS. 51 and 52).

Movement oflinks40a,40btoward the second position moves the distal ends132 oflinks40a,40bdistally withinhousing20. As discussed above, the distal ends132 oflinks40a,40bis axially fixed to theproximal end80 of thecamming member46 by thepivot members130.

As such, when handles22 are actuated,camming member46 is directly driven and moved distally. Thespring60 is positioned about theproximal end80 of thecamming member46 and abuts aspring stop134 supported within inproximal end126 of thehousing20 to urge thecamming member46 to its retracted position. As mentioned, ascrew30 is disposed through thestop34.

Referring still toFIG. 9, thehandle portion12 includes an anti-reverse ratchet mechanism which includes apawl56, arack42 and a pawl biasing member orpawl spring57. Therack42 includes a series ofteeth136 and is supported within arecess138 formed in housing half-section20bshown inFIG. 5. In one embodiment,recess138 is dovetail shaped and the backside ofrack42 has adovetail shape projection140 which is slidably received withinrecess138 to securerack42 withinhousing20b. Alternately, other fastening techniques can be used to securerack42 withinhousing20b, e.g., adhesives, pins, welding, etc.

Referring now toFIG. 11, thepawl56 has a generally “C” shaped configuration with an arc having afinger54 extending therefrom and abore142 dimensioned to receivepivot member140 such that thepawl56 is rotatably mounted tocamming member46 and thelinks40a,40baboutpivot member140. Thepawl spring57 includes a pair of mountingholes144,146 for securingprotrusions148 from theplate extension150 through the camming member46 (FIG. 11) of theclip applier10. Thepawl biasing member57 also includes asemi-circular cutout152 which is positioned to be clipped partially aboutpivot member140, and has a cantilever orspring arm154 which is positioned within aside156 formed in a side ofpawl56.

Pawl finger54 is resilient and provides a biasing force to urgepawl56 to a position in which pawlfinger54 is substantially perpendicular thearm154 and generally to the longitudinal axis of thecamming member46. Thepawl finger54 is positioned to engageteeth136 of the rack42 (FIG. 5) and to retain thecamming member46 at partially advanced positions during actuation ofclip applier10 against the bias ofspring60 which urges thecamming member46 to its retracted position. The anti-reverse ratchet mechanism of thepawl56 prevents retraction of thecamming member46 after thehandles22 have been partially actuated and until theclip applier10 has been fully actuated.

Referring now toFIG. 15, there is shown a bottom view of thecover200 with thetissue stop24 extending from a distal side. Beneath thecover200 or shown on a top side of the cover given that thecover200 is inverted for illustration purposes, there is shown a view of theclip retainer spring106 connected to the cover. Theclip retainer spring106 has acurved portion108 that extends opposite thehousing14. Thecurved portion108 holds the distalmost clip86 of theclip stack88 until such time as theclip pusher300 advances the distalmost clip86 past thecurved portion106 and between thejaws16,18.

FIG. 16 shows an assembled view ofclip applier10 with theclip stack88, thejaws16, and18, thecamming member46, theclip retainer spring106 and theclip follower300. Referring now toFIG. 17, there is shown a distal exploded view of theclip retainer spring106 with thecover200 removed for illustration purposes. Theclip retainer spring106 has thecurved portion108 that extends opposite thehousing14. Thecurved portion108 deflects a predetermined amount to hold the distalmost clip86 of theclip stack88 untilclip pusher300 advances the distalmost clip86 past thecurved portion106 and between thejaws16,18.

Referring now toFIG. 18, there is shown an exploded view of theclip channel68 having the row of clips or stack88 being disposed in thechannel68 and biased by theclip follower300. As can be understood from the figures, theclip stack88 is simply supported on theseparator plate500 as shown inFIG. 8. Alternatively, theclip applier10 may be formed with a channel housing (not shown) that is disposed on theseparator plate500, for further retaining the clip stack therein. Referring to the enlarged area of detail shown ascircle24 ofFIG. 18 best shown asFIG. 24, thelockout700 has thelockout engagement member708 that extends in an upward direction through theseparator plate500 and for simply contacting with thelockout member512 on theseparator plate500 to initially limit the distal movement of thelockout member700. In this manner, thelockout700 allows for operation of theclip applier10 as there are a sufficient number of clips in thestack88 as determined by thelockout tab314 ofclip follower300 being proximal of thelockout engagement member708.

FIG. 19 shows theclip follower300 in an exploded perspective view. Theclip follower300 is biased by a suitableclip follower spring400. Thespring400 is a helical compression spring that is disposed to surround and connect to the proximal end ormember310 of theclip follower300. In this manner, theclip follower300 is biased and advances each of the clips of thestack88 in a distal most direction for loading between thejaws16,18 as shown.

FIG. 21 shows thelatch48 on a bottom side thereof. Thelatch48 is connected to theseparator plate500 by thepusher spring616 that is connected to hook516 on the opposite side relative to thelatch48. As can be understood from the drawings, thelatch48 is biased by thelatch spring94 that is connected to thestationary plate500. Referring now toFIG. 22, there is shown thelockout member700. As discussed above, thelockout member700 has a pair oflegs704,706. Each of thelegs704,706 move and traverse intorespective notch120 formed in the sidewalls of thecamming member46. Thelockout member700 further has thespring aperture712. Thelockout spring724 is disposed in theaperture712 to bias thelockout member700 relative to thestationary separator plate500. The opposite distal side of thespring724 is connected to an interiorfirst hook508 as shown.

Referring now to the distal most exploded view of thejaw16,18 connected with thejaw body800 shown asFIG. 23, thedistal finger604 of theclip pusher600 contacts a distalmost clip86 at an apex A of the clip. In this manner, when theclip pusher600 is advanced distally, theclip pusher600 having thedistal finger604 will contact the apex “A” and move the clip in a distal most manner.FIG. 24 shows an enlarged area of detail of theclip applier10. Here, advantageously theclip applier10 may be fully locked out when there are few or no remaining clips in thestack88 above theseparator plate500 or in any clip carrying channel.

In this manner, the surgeon cannot dry fire, or in other words fire the instrument without any clips in thestack88. Referring again toFIG. 24, theseparator plate500 has thelockout member512. Thelockout member512 is connected to theseparator plate500 or is integral withseparator plate500, and contacts thelockout engagement member708. As thelockout engagement member708 moves distally though the stroke, thelockout engagement member708 will contact thelockout member512 and the lockout engagement member's708 distal movement is limited to allow for operation of the instrument.

Referring now toFIGS. 25 and 26, theclip applier10 has thelockout700 with thelockout engagement member708 shown in thechannel68. Theclip pusher600 is disposed over thecamming member68. Referring now toFIG. 26, each of thelockout legs704,706 is biased and will mate with thenotch120 formed in thesidewall122 of thecamming member46. Thenotch120 is an orthogonally shaped slot.Notch120 has a height suitable to permit therespective leg704,706 to enter or a portion to enter and be locked therein.Notch120 also is narrow and does not permit thelegs704,706 contact with the outer surface of thehousing body14. As thelockout700 is advanced distally, thelockout legs704,706 will advance and enter thenotch120. Once thelockout legs704,706 enter into thenotch120, thelockout legs704,706 will be free from contact with thesidewalls122 of thecamming member68 and spring outward toward opposite thesidewalls122 and be biased in thenotch120. Thereafter, thelegs704,706 are permanently retained innotch120 and cannot escape therefrom.

Referring now toFIG. 25, theclip applier10 also has ajaw locking member66. Thejaw locking member66 is a resilient member that is connected by the pin or connector to thehousing body14 and has thearm116 at a freedistal end118 that extends between thejaws16,18 of thejaw body800. Thejaw locking member66 extends between thejaws16,18 and prevents thejaws16,18 from camming closed in a premature fashion. Thefree arm116 at thedistal end118 of thejaw locking member66 is rigid and resilient and extends between thejaws16,18. Advantageously, thejaw locking member66 can deflect relative to its original position and be stowed in a second lowered position when theengagement member84 of thecamming member46 contacts and pushes thejaw locking member66 to contact theouter cam surface808 of thejaws16,18. Referring now toFIG. 26, thecamming member46 moves distally andengagement member82 will cam down thearm116 on the freedistal end118 of thejaw locking member66 and provide that thejaw locking member66 does not extend between thejaws16,18, and instead is below thejaws16,18. Thecamming member46 will then cam thejaws16,18 closed without thejaw locking member66 interfering. If thecamming member46 is not at the fully actuated or in the distal most position, then thejaw locking member66 will remain between thejaws16,18, and thus prevent thejaws16,18 from accidentally be cammed closed. Thus, theclip applier10 controls thejaws16,18 in an unactuated position to prevent stray movement which can slightly damage, knick or deform the distalmost clip86 as theclip86 is advanced between thejaws16,18.

Operation of theclip applier10 will now be described with reference toFIGS. 27 and 28 which show a side view and a top view of theclip applier10 having the multiple subassemblies.

Referring toFIG. 29, there is shown a top view of theclip applier10.FIGS. 29 and 30 illustrate theclip applier10 prior to actuation ofhandles22, i.e., in the prefired position. In the prefired position, thecamming member46 has thespring60 connected to a proximal most portion of thehandle housing20. Thespring60 thus is connected to both thecamming member46 and thehandle housing20 and thespring60 will urge thecamming member46 to its retracted position when thecamming member46 is advanced distally.

As shown, inFIG. 29, thepawl56 is proximal relative to therack42. As thehandles22 are closed, thelinks40a,40bwill be advanced to move thecamming member46 in a distal manner. Thepawl56 as being advanced will move past therack42. Thepawl56, if thehandles22 are released in mid stoke such as, for example, where the surgeon must attend to another surgical event and cannot complete the handle stroke, thefinger54 of thepawl56 will engage with theteeth136 of therack42 and thus prevent thecamming member46 from retracting proximally or moving freely distally and thus potentially damaging a clip being between thejaws16,18.

Referring now toFIG. 30, there is shown a lateral side cross sectional view of theclip applier10 along line30-30 ofFIG. 29. As shown, thecamming member46 is connected to thespring60, and thepawl56 is connected through thecamming member46 as shown. Theclip applier10 further has thelatch48. As thecamming member46 is advanced distally due to thehandles22 being closed, thelatch member48 will also be driven distally and then will contact anotherengagement surface96′. This contact between thelatch48 and theengagement surface96′ will cause thelatch48 to cam in a direction upwards against thesurface96′.

Referring now toFIG. 31, there is shown a cross sectional distal view of theclip applier10. As shown, theclip applier10 has the number of clips in theclip stack88. As shown in the distal most region of theclip applier10, theclip retainer spring106 prevents the distalmost clip86 from being advanced in between thejaws16,18. Moreover, the curved orbent clip portion108 of theclip retainer spring106 extends below the clip. As shown in cross section, theengagement member84 connected to thecamming member46 is in a proximal most position being unfired. Moreover, thelockout700 is also in a proximal most position.

Referring toFIG. 32, there is shown a top view of theclip pusher600 withfinger604 being near an apex of the distalmost clip86. The clip pusher600 (upon being advanced) will advance the distalmost clip86 underneath thecurved clip member108 of the clip retainer spring106 (FIG. 31) and then be able to travel further distally in order to travel between thejaws16,18. One should appreciate that upon manipulating theclip applier10 not by thehandles22, (by simply picking up theclip applier10 prior to use or by simply resting theclip applier10 before use on a table) one cannot overcome the bias of theclip retainer spring106 and the clips will be held in thestack88 until theclip applier10 is fired.

Referring back toFIG. 31, as can be seen thejaw locking member66 has the blockingarm116 portion that is extending between thejaws16,18. Here, if the orientation of theclip applier10 is disturbed, thejaws16,18 will not close or move relative to one another and will be prevented from doing so because of thearm116 of thejaw locking member66 that extends upward. Theengagement member84 as it is advanced distally will cam down thejaw locking member66 and then permit thejaws16,18 to be free and move relative to one another and compress a clip disposed therebetween.

FIG. 33 shows the relative placement of thelockout700 having thelockout legs704,706 and thenotch120 in thecamming member46. Thelockout spring724 is connected to thelockout700 through thespring aperture712 as shown inFIG. 22 in order to bias thelockout member700 relative to theseparator plate500. Referring to a distal most portion of the figure, as shown thecamming member46 has thenotches120 in a lateral side.

As can be understood as thelockout700 is moved distally, thelockout legs704,706 will mate into thenotch120 of thecamming member46 and thus prevent further distal movement of thelockout member700. Referring to a top view of theclip applier10 shown inFIG. 34, thelockout engagement member708 shown in phantom dotted lines is under theseparator plate500 and also extends upward to a position adjacent thebody housing14. Thelockout engagement member708 will lock thelockout700 and thecamming member46 at a predetermined line of demarcation such as when there are few clips remaining.

Referring to a proximally located original position, theclip follower300 is disposed in a proximal most position as shown behind and advancing the clips distally from thestack88 to be fired. Referring now toFIGS. 35 and 36, there is shown theclip follower300 with thespring400 being disposed behind theclip follower300. As shown, thelatch member48 cams upwardly in direction being about perpendicular to the driving of thecamming member46. Referring toFIG. 36, thefollower300 is shown biasing the proximalmost clip104 in theclip stack88.

FIG. 37 shows the orientation of theengagement member84 and thejaws16,18 on thejaw body800. As can be seen from the figure, thejaw body800 has theouter camming surface808. Theouter camming surface808 is curved slightly and defines an outer surface of thejaws16,18 on thejaw body800. Theengagement member84 is a rectilinear member having aninterior space808′ that fits over theouter camming surface808 of thejaws16,18.

Theengagement member84 will be advanced distally, and contact theouter camming surface808 of thejaws16,18. As thecamming member46 progresses through the stroke, theengagement member84 contacts theouter camming surface808 of thejaws16,18 and forces thecamming surface808 in a direction inwardly by the contact. Thus, thejaw body800 connected to thehousing body14 will not move and thus force close thejaws16,18. Thejaws16,18 in turn apply a compressive force to the clip therebetween.

Referring toFIG. 38, there is shown a cross sectional view of thechannel68 of theclip applier10. As shown, in cross section, theclip applier10 has the distalmost clip86 above theseparator plate500. Thejaws16,18 of theclip applier10 are in the distal most portion of the view in the unactuated state. As can be seen thejaw locking member66 is disposed between thejaws16,18 to prevent any accidental compression or closing of thejaws16,18. Further, theclip applier10 has theengagement member84 in an unactuated state, or disposed proximal relative to theouter cam surface808 of thejaws16,18. As theengagement member84 is driven distally theengagement member84 will contact theouter camming surface808 of thejaws16,18 to compress thejaws16,18 and compress the clip advanced between thejaws16,18. In this view, theouter camming surface808 is proximal and behind thejaws16,18. Referring toFIG. 39, as thehandles22 are closed, thepawl spring56 drives thepawl56 in the direction of reference arrow “F” and thepawl finger54 contacts theteeth136 of therack42. As thepawl finger54 contacts theteeth136 of therack42, thepawl56 maintains thecamming member46 in position to prevent an accidental or a partial actuation of theengagement member84. Instead, thefinger54 of thepawl56 will (when thehandles22 are released) maintain a position being disposed between theteeth136 of therack42. This allows thepawl56 to remain in position until thehandles22 are further closed or compressed where thepawl56 will then be further advanced over theteeth136 of therack42.

FIG. 40 shows the beginning of the stroke. Thehandles22 are compressed in a scissor like fashion in a direction B toward thehandle body20. In this manner, thelinks40a,40bwill move thecamming member46 in a distal manner, as shown by reference arrow “C”. As shown inFIG. 39, thepawl56 andrack42 will maintain thecamming member46 in an intermediate position if thehandles22 are prematurely released in mid-stroke.FIG. 41 shows a cross sectional side view of theclip applier10 at the beginning of the stroke. As can be seen, thecamming member46 is connected by the stretchedspring60 to thehousing20. As shown in the proximal section, thecamming member46 is connected to thespring60 by thehook58 and thespring60 is also connected to thehousing20.

As can be understood, thespring60 biases thecamming member46 to return to the original proximal most position once the handle are released.FIG. 42 shows an enlarged detail of thereference circle42 shown inFIG. 41.FIG. 42 shows theclip follower300 being disposed above thelatch driver50 and thelatch48. As thecamming member46 is advanced distally, thecamming member46 will also urge thelatch driver50 distally. Thelatch driver50 upon being moved distally will advance thelatch48 to move in a perpendicular direction relative to the movement of thecamming member46. This will urge theclip pusher600 to move distally.

Referring now to a distal most section of theclip applier10, shown in cross section inFIG. 43, theclip pusher600 will advance the distalmost clip86 past thecurved clip member108 of theclip retaining spring106 as shown by reference arrow “G”. As can be understood, theclip retaining spring106 will be deflected upward in the direction of the reference arrow “H”. In this manner, theclip pusher600 can advance the distalmost clip86 in a direction toward thejaws16,18, and theclip retaining spring106 will then deflect downward as shown by reference arrow “I” inFIG. 44 and thecurved clip member108 of theclip retaining spring106 will then be advanced back into the path of the next clip to then terminate the movement of the next clip and prevent the next clip from interfering with the operation of theclip applier10 as shown inFIG. 44.

Referring once again toFIG. 43, theengagement member84 of thecamming member46 is shown in a first proximal position relative to theouter camming surface808 of thejaws16,18 and thejaw locking member66. Referring toFIG. 44, thecamming member46 is then advanced further distally, and thus further advances theengagement member84. One should appreciate that thejaw locking member66 in this position prevents any actuation of thejaws16,18, as thejaw locking member66 has thearm116 that is disposed between thejaws16,18 to prevent thejaws16,18 from closing.

Referring now toFIG. 45, theclip follower300 is shown being disposed above theclip pusher600. Theclip pusher600 further has a hooked portion connected to thespring616 that connects to thesecond hook516 of theseparator plate500. Thespring616 is connected to thestationary separator plate500 to bias theclip pusher600. In this manner, thespring616 once elongated biases theclip pusher600 to the original proximal most position.

Referring now toFIG. 46, as thecamming member46 is further moved through the stroke, theclip pusher600 continues to advance the distalmost clip86 between thejaws16,18. Thecamming member46 also further moves theengagement member84 further in a distal most direction. As can be seen fromFIG. 46, theengagement member84 is closer and adjacent to thejaw locking member66 to deflect thearm116 in a direction downward and to move thearm116 of thejaw locking member66 from between thejaws16,18 to beneath thejaws16,18.

Referring now toFIG. 47, one can appreciate that now the distal most clip has been loaded in between thejaws16,18, theclip pusher600 is free to retract so as to permit other assemblies of the clip applier access to the loadedjaws16,18 to compress the clip.FIG. 47 shows thelatch driver50. At this predetermined demarcation line of the stroke, thelatch driver50 will cam the latch48 (to contact theabutment96′) and cam thelatch48 out of engagement of thelatch driver50. Referring toFIG. 48, thelatch50 andclip pusher600 free of contact with thelatch driver50 will now traverse proximally out of engagement with thelatch driver50 and retract. Theengagement member84 and thelatch driver50 will continue to traverse distally.

Referring toFIG. 48, as cammingmember46 andclip pusher600 advance within thechannel68, the tension in thelatch48 is increased, i.e.,spring94 and thelatch48 is cammed out of engagement with thedriver50 and will retract. Whendistal-most clip86 is fully positioned withinjaws16 and18, thelatch driver50 disengages a distal end oflatch48 and pivots latch48 in the direction indicated by arrow “J” (FIG. 47) to release thelatch member48 from theabutment member96′ (FIG. 48). Whenlatch member48 is released fromabutment member96′, thelatch spring94 returns theclip pusher600 to its retracted position.

Referring now toFIG. 49, as thehandles22 are more fully actuated, i.e., moved closer tohousing20, theengagement member84 engagesarm116 of thejaw locking plate66. Theengagement member84 will then deflect thejaw locking plate66 in a direction downwardly from betweenlegs804,806 of thejaws body800. The continued advancement of thecamming member46 advances theengagement member84 into the outer camming surfaces808 ofjaws16 and18 to movejaws16 and18 from a spaced apart position to a crimping position as shown inFIG. 50.

Referring toFIG. 51, as thecamming member46 is moved from its retracted position withinhousing body14 to the advanced position, a finger of thepawl56 engagesteeth136 of therack42 to prevent thepawl spring54 from returning thecamming member46 to its retracted position when thehandles22 are released part way. As such, once handles22 begin to be actuated and thepawl finger54 engages the rack42 (FIG. 51) thecamming member46 cannot be returned to its retracted position untilclip applier10 is fully actuated.

When thecamming member46 is moved to its advanced position, thepawl56 passes by a distal most end ofrack42 as shown inFIG. 52 and cantilevered orspring arm158 of thepawl spring57 rotatespawl56 in the direction indicated by arrow “K” inFIG. 52 to a position in whichfinger54 ofpawl56 is positioned at about 90 degrees relative to thecamming member46. Thus, when thehandles22 are released and thespring60 returns thecamming member46 to a retracted positioned, thefinger54 will engage the distal end ofrack42 and rotate counter-clockwise in the direction indicated by the opposite of arrow “K” inFIG. 52 and ratchet overteeth136 of therack42. Note, in the fully retracted position of thecamming member46, thepawl56 is positioned proximally ofrack42. In this position thepawl spring57 returns thefinger54 ofpawl56 to the 90 degree position relative to thecamming member46.

Referring now toFIG. 53, theengagement member84 is advanced to its distal most position and contacts the outer camming surfaces808 of thejaws16,18 to close thejaws16,18 and compress a clip therebetween.FIG. 54 shows theclip86 compressed around a vessel for occluding the vessel. Referring now toFIG. 55, thehandles22 being released will permit thespring60 to impart a force to thecamming member46 in the proximal direction “L” in order to retract thecamming member46 to it initial position for firing of the next clip.

FIG. 56 shows theclip applier10 with a novel lockout mechanism that will lockout theclip applier10 after the last or a predetermined last clip is fired from theclip applier10. This is especially advantageous as theclip applier10 is not dry fired or fired without any further clips in theclip applier10. The lockout mechanism provides theclip applier10 with a tactile feedback to the surgeon that theclip applier10 is out of clips and a new full clip applier is needed.

Referring now to thereference circle57 shown inFIG. 56, theclip follower300 has thelockout tab314. As discussed previously, thelockout tab314 is disposed on a lateralproximal side316 of theclip follower300. Thelockout700 also has alockout engagement member708 that extends upwardly through thechannel68. In a normal state of operation of theclip applier10, thelockout engagement member708 cannot traverse past thelockout member512 on thestationary plate500, and is blocked from moving distally.

The follower300 (at a predetermined line of demarcation once a number of clips of thestack88 have been exhausted and fired from the clip applier10) will move distally given that the number of clips in thestack88 has been reduced. Theclip applier10 has thelockout tab314 that will contact asloping surface750 of thelockout engagement member708 and move thelockout engagement member708 outward in the direction of reference arrow M. Once thelockout engagement member708 moves outwardly, thelockout engagement member708 can now move distally or past thelockout member512 on theseparator plate500 in the direction of reference arrow P. Theclip follower300 thus moves thelockout engagement member708 in a distal most direction as indicated by reference arrows “M” and “P” onFIG. 58.

Thelegs704,706 of thelockout700 will then move outwardly and into thenotch120 being formed on thecamming member46. In this manner, thelockout legs704,706 snaps into thenotch120 and cannot be removed therefrom.

Further, thelockout700 has a roundeddistal end tab720 that mates with a stepped downstop member810 on thejaw body800. This interface prevents thelockout engagement member708 and thecamming member46 from moving distally and thus lockouts out theclip applier10 and prevents and further operation of theengagement member46, theclip pusher600 and theclip follower300. Instead, thehandles22 will be fixedly in place and when squeezed will provide the surgeon will a great deal of tactile resistance. This will provide the surgeon with an indication that theinstrument10 has no remaining clips, needs to be discarded and replaced with afresh clip applier10.

It will be understood that various modifications may be made to the embodiments disclosed herein. Therefore, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.

Claims (22)

What is claimed is:

1. An apparatus for applying surgical clips comprising:

a body portion housing a clip stack; and

a pair of jaws supported at a distal end of the body portion;

the body portion including a clip pusher, a camming member and a clip follower, the clip pusher being movably positioned within the body portion and being operable to advance a distal-most clip from the clip stack to a position between the pair of jaws, the camming member being movably positioned within the body portion and being operable to approximate the pair of jaws to deform the distal-most clip, and the clip follower being positioned proximally of the clip stack and operable to urge the clip stack distally towards the pair of jaws;

wherein the body portion further includes a lockout member having a plurality of stop members, the lockout member being movable from a first position in slidable relation to the camming member to a second position interlocked with the camming member;

wherein the camming member has at least one notch;

wherein in a second position, the lockout member has at least one of the stop members being positioned to interface with the at least one notch, the engagement between the at least one stop member and the at least one notch limiting distal movement of the camming member; and

wherein the clip follower actuates the lockout member when the clip follower advances to a predetermined clip in the clip stack.

2. An apparatus according toclaim 1, wherein the lockout member includes at least one flexible leg having a projection and the camming member includes at least one notch; and

wherein the notch has a size configured to receive the projection to lock the lockout member to the camming member.

3. An apparatus according toclaim 2, wherein the lockout member includes a plurality of flexible legs and the camming member has a plurality of notches configured to receive at least a portion of the plurality of flexible legs.

4. An apparatus according toclaim 1, wherein the lockout member includes an engagement member which is positioned to releasably retain the lockout member in the first position, the engagement member being biased to a stationary surface in the apparatus.

5. An apparatus according toclaim 1, wherein the clip follower has a lockout nub; and

wherein the lockout nub of the clip follower moves the engagement member to move the lockout member from the first position to the second interlocked position.

6. An apparatus according toclaim 5, wherein the lockout nub of the clip follower moves the engagement member of the lockout member after a predetermined clip has been advanced between the jaws.

7. An apparatus according toclaim 1, wherein the clip follower actuates the lockout member when the clip follower advances to one of a last clip in the clip stack, a second to last clip in the clip stack, and a third to last clip in the clip stack.

8. An apparatus according toclaim 1, further comprising a clip retainer member, the clip retainer member configured to bias the clip stack proximally, the clip retainer member limiting movement of the stack so only a distal most clip is advanced between the jaws by the clip pusher.

9. An apparatus according toclaim 8, wherein the clip retainer member is curved having a portion configured to block the stack.

10. An apparatus according toclaim 1, further comprising a member having a cantilevered free end and a fixed end connected to the housing, the cantilevered free end extending between the jaws to prevent accidental compression of the jaws, and being adapted to be deflected about the fixed end to permit the jaws to be closed.

11. An apparatus according toclaim 10, wherein the camming member deflects the member as the camming member is advanced distally to close the jaws.

12. An apparatus according toclaim 10, wherein the member has the cantilevered free end extending between the jaws and the fixed end connected to the housing connected by a pin.

13. An apparatus for applying surgical clips comprising:

a body portion housing a clip stack; and

a pair of jaws supported at a distal end of the body portion;

the body portion including a clip pusher, a camming member and a clip follower, the clip pusher being movably positioned within the body portion and being operable to advance a distal-most clip from the clip stack to a position between the pair of jaws, the camming member being movably positioned within the body portion and being operable to approximate the pair of jaws to deform the distal-most clip, and the clip follower being positioned proximally of the clip stack and operable to urge the clip stack distally towards the pair of jaws;

wherein the body portion further includes a lockout member having a plurality of stop members, the lockout member being movable from a first position in slidable relation to the camming member to a second position interlocked with the camming member;

wherein the camming member has at least one notch;

wherein in the second position, the lockout member has at least one of the stop members positioned to interface with the at least notch to limit distal movement of the camming member;

wherein the clip follower actuates the lockout member when the clip follower advances to a predetermined clip in the clip stack;

wherein the apparatus has a latch assembly supported on the clip pusher, the latch assembly including a pivotal latch member movable from a first position to engage an aperture supported on the clip pusher to load a clip between the jaws to a second position, the second position to disengage therefrom and retract the clip pusher; and

wherein the camming member is operably connected to a movable handle such that movement of the at least one movable handle through an actuation stroke effects movement of the camming member from the advanced position to the retracted position.

14. The apparatus ofclaim 13, further comprising a clip retainer spring connected to a distal inner surface of a cover.

15. The apparatus ofclaim 14, wherein the clip retainer spring has a portion to limit distal movement of the clip stack.

16. The apparatus ofclaim 13, further comprising a safety device configured to prevent accidental compression of the jaws.

17. The apparatus ofclaim 14, wherein the safety device has a first free end that extends between the jaws at the initial position of the camming member.

18. The apparatus ofclaim 14, wherein the safety device has the first free end that is deflected from between the jaws at the advanced position of the camming member.

19. The apparatus ofclaim 16, wherein the lockout member has a distal tab, the distal tab being engageable with a stationary surface in the body to prevent distal movement of the lockout member at the second interlocked position, the distal tab limiting distal movement of the camming member.

20. The apparatus ofclaim 19, wherein the camming member is directly connected to a pair of handles with each handle connected to the camming member by a link.

21. The apparatus ofclaim 20, wherein the camming member has an orthogonal distal member configured to contact an outer camming surface of the jaws and configured to close the jaws.

22. The apparatus ofclaim 20, further comprising a rack having a plurality of teeth, the camming member having a pawl, the pawl contacting the teeth as the camming member is advanced distally to prevent retraction of the camming member until the jaws are fully compressed.

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